KIMBERLEY BLAKE MA, NCC, LPC
NPI 1922771765
Counselor - Professional in Bridgeport, CT

Active since July 28, 2021PECOS EnrolledAccepts Medicare Assignment
140 JOHN ST, BRIDGEPORT, CT 06604(203) 450-9944 Get Directions Write a Review

NPPES record last updated: July 28, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kimberley Blake Ma, Ncc, Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLEY BLAKE MA, NCC, LPC (NPI 1922771765) is an individual professional provider in Bridgeport, Connecticut, licensed in Connecticut (004945) and active in the NPI registry since July 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1922771765
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameKIMBERLEY BLAKECredential: MA, NCC, LPC
Location Address140 JOHN STBridgeport, CT 06604-4323
Mailing Address140 John StBridgeport, CT 06604-4323 · (203) 450-9944
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateJuly 28, 2021
NPPES CertifiedJuly 20, 2021
NPI 1922771765 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License Licensed in CT · 004945
140 JOHN ST, Bridgeport, CT 06604

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Kimberley Blake Ma, Ncc, Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9638521958
PECOS Enrollment IDI20240122004091
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor
140 JOHN ST
BRIDGEPORT, CT 06604
Social Worker (Clinical)
140 JOHN ST
BRIDGEPORT, CT 06604

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberley Blake's NPI number?

The NPI number for Kimberley Blake is 1922771765. It was assigned to this individual provider in the NPPES registry on July 28, 2021.

Where is Kimberley Blake located?

Kimberley Blake practices at 140 John St, Bridgeport, CT 06604. The listed phone number is (203) 450-9944.

What is Kimberley Blake's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Kimberley Blake enrolled in Medicare?

Yes. Kimberley Blake is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Kimberley Blake was last updated on July 28, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.